Provider Demographics
NPI:1548407299
Name:SHEPPARD, HARRY P (RFO, LO)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:P
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:RFO, LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4614
Mailing Address - Country:US
Mailing Address - Phone:918-742-6464
Mailing Address - Fax:918-742-9933
Practice Address - Street 1:2116 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4614
Practice Address - Country:US
Practice Address - Phone:918-742-6464
Practice Address - Fax:918-742-9933
Is Sole Proprietor?:No
Enumeration Date:2009-01-17
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLO22222Z00000X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter